Hearing and Legal Services Officer I / Juris Doctor

• Review and decide appeals:
• Go through appeal requests and case documents to prepare for and conduct hearings. Write clear decisions based on facts and legal rules, following fair hearing standards and deadlines.
• Use legal knowledge:
• Apply laws, rules, and procedures to make fair and accurate decisions. Do legal research, analyze evidence, and manage your cases independently to meet timelines.
• Ensure fairness and respect:
• Provide respectful and professional service to everyone. Make sure each person gets a fair hearing and help maintain a positive team environment.

Reporting:

• This role reports to the Eligibility Cases Manager.

Required knowledge, skills, and abilities (KSAs):

• Experience in a fast-paced, deadline-driven environment
• Experience independently managing a caseload to meet established time frames
• Experience with internal and external stakeholders
• Knowledge of administrative law and/or appeals procedures
• Considerable experience applying rules to facts to reach logical, legally supportable conclusions
• Considerable experience interpreting, applying, and analyzing federal and state complex laws, regulations, policies, or case law
• Considerable experience in legal analysis and legal writing
• Considerable knowledge of legal research methodologies, including computerized legal research
• Considerable experience with technology, including MS Office
• Admission to the Virginia State Bar in good standing, or eligible for admission to the Virginia State Bar within six months from the start date in the position.

Additional Considerations:

• Experience drafting appeal decisions.
• What work actions and/or decisions are made without prior approval? To what extent is the incumbent required to seek advice and guidance from the supervisor?
• Independently manage issues and risks proactively and exercise strong business judgment in escalating matters to the Eligibility Cases Manager.
• Independently research state and federal laws, regulations, and policy.

Role & Responsibilities:

• Conduct thorough hearing preparation and hearings for all Medicaid appeal cases assigned to inventory.
• Follow all rules and procedures set by the Appeals Division
• Use the Appeals Information Management System (AIMS) effectively to track cases, complete tasks, add notes, and manage appeal activities
• Keep case records accurate and up to date by regularly updating files and logging actions in AIMS
• Handle your own set of cases and complete hearing prep work on time
• Research legal issues thoroughly and stay informed about current laws, policies, and regulations that affect appeal decisions
• Lead client eligibility appeal hearings using proper legal procedures, ensuring fairness and due process
• Share case-related data and performance metrics with the Eligibility Cases Manager when requested.
• Draft and issue legally supportable state fair hearing decisions in accordance with all deadlines.
• Follow all established procedures of the Appeals Division
• Use the Appeals Information Management System (AIMS) confidently to:
• Attach hearing recordings
• Upload final decisions and exhibit packets
• Handle decision submissions, including resubmission requests
• Ensure decisions are released on time so they can be mailed by the print vendor before the deadline
• Apply laws, rules, regulations, and policies to make fair and well-reasoned written decisions based on facts and legal conclusions
• Submit decisions to the Quality Assurance Team within required timeframes, focusing on meeting federal deadlines
• Make sure all decisions are released in AIMS before their due dates
• Share performance data and case metrics with the Eligibility Cases Manager when requested
• Collaborate with Appeals Division team members.
• Build productive working relationships with peers and work collaboratively to manage the flow of appeals
• Assist with increased workload volume across teams, as requested
• Complete assigned tasks and projects in a timely manner
• Communicate effectively both orally and in writing with various staff members as it relates to assigned tasks and projects
• Assist with training, as requested, to ensure continuity of operations
• Immediately escalate issues between peers to management to ensure that an effective resolution can be reached in a timely manner

Special Assignments:

• Special assignments are made at the request of the Eligibility Cases Manager, General Operations Manager, and Division Director.
• Satisfactory completion of assignments within timeframes established by the Eligibility Cases Manager, General Operations Manager, and Division Director.

About our Company: –
22nd Century Technologies, Inc., is one of the fastest growing IT Service Integrator and Workforce Solution companies in the United States. Founded in 1997, 22nd Century Technologies is a Certified National Minority Business Enterprise with 6,000+ people including 600+ Cyber SMEs nationwide supporting our customers in all 50 states, Canada, and Mexico. With HQs in Somerset, NJ and Mclean, VA, 22nd Century has 14 offices throughout the United States. As part of our unrelenting focus on quality and compliance, 22nd Century Technologies’ delivery is based on Certified Matured Processes including CMMI L3 Dev & SVC, ISO 20000, ISO 27001, and ISO 9001 quality processes. With a strong focus on the public sector, 22nd Century currently holds government contracts with 14 out of 15 Federal Executive agencies including DoD, 37 other Federal agencies, 50 States, 115+ Local agencies, and 37 School Districts. In the last three years, we have expanded our services to Fortune 500 and other commercial clients and currently support 80+ commercial clients.
Recognized among “Best Company to Work For” by Forbes, 22nd Century Technologies, Inc., consistently exceeds our clients’ expectations by focusing on their absolute satisfaction with jobs while keeping our employees motivated.
“22nd Century Technologies is an Equal Opportunity Employer” and “US Citizens & all other parties authorized to work in the US are encouraged to apply.”
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.